PRINCIPLES OF SURGERY

Dr. Flori Puspa Humani

Tutor: Prof. dr. Kamardi Thalut, Sp.B
UNIT MAP: FOLLOW ALONG IN YOUR
PACKET

WHAT ARE YOU LEARNING?

Explain basic principles of surgery, laceration
healing, and surgery considerations
 KNOW UNDERSTAND DO!

Know Understand
Do
 Basic Principles • Surgery principle
• Outline surgery
significance
of Surgery basics
• Laceration healing
 Laceration • Explain healing
• How to determine
types etc considerations • Compare/Contrast
 Surgical Considerations
Considerations
 KEY LEARNING: SURGICAL CONSIDERATIONS

 Unit EQ: Why is surgery important in vet

practices?
Concept
Concept : Laceration Concept :
Surgical Principles Healing
Lesson EQ: Surgical
Lesson EQ:
Considerations
What is one How does a wound
basic principle heal?
Lesson EQ:
of surgery? Vocab How are
Vocab considerations
First Intention Healing,
golden period, determined?
Sterilization,
Autoclave, hemtoma Vocab
Disinfectants GDV, Necrotic,
SURGICAL PRINCIPLES

 Reminders:
 Skin and mucous membranes provide barrier to
outside world
 THEREFORE
 Surgery disturbs this barrier and allows for bacterial entry
BASIC PRINCIPLE = MOST IMPORTANT?:

 Prevention of Bacterial Entry through barrier

 Environment has bacteria everywhere!
 Aseptic Technique
 General practices used to minimize the risk of infection
 Must be comprehensive!

 Includes
 Management of facility, patient, surgical site, surgeon and
equipment
ASEPTIC CONTINUED

 Disinfectants:
 Usedto clean facility, used on inanimate objects
 Normally too harsh for direct skin contact
ASEPTIC CONTINUED

 Sterilization:
 Tools are potential bacteria carriers
 Instruments are cleaned of debris
(tissue etc)
 Kills all micro-organisms

 Uses pressure and steam

 Autoclave : tools packed in steaming
wrap, 15 to 30mins at 275 degrees
ASEPTIC IN THE CLASSROOM AND LAB

 Common Procedures
 Outline

 Categorize

 Explain how they work

 What safety considerations are outlined? Are

they visible to the naked eye? Where is the
safety information located?
 How to read an MSDS Activity
Common Tools

PRINCIPLES OF SURGERY
COMMON TOOLS AND PURPOSE

 Scalpel
 Needle Holder

 Scissors

 Tissue forceps

 Hemostatic Foreceps

 Retractors

 Towel Foreceps/Clamps

 Spay Hook
SCALPEL

 Provides clean incision

 Typical designed for single use
 Disposal , removal off handle
 Varying Sizes and Shapes
NEEDLE HOLDER

 Holds needle for suturing

 Teeth provide strong grip

 Insert replaced as teeth wear out

SCISSORS

 Various Shapes and Sizes

(depends on surgery)
 Curved = more
maneuverable
 Straight= cut through
tough tissue
 Normally in packs
 Metzenbaum – delicate
tissue
 Mayo – tough tissue
TISSUE FORCEPS

 Appear like tweezers

 Tip will vary depending on use
 Serrated= delicate tissue holding
 Heavy teeth= secure grip

 Ratchet locking grip= secure hold (prolonged grip)

Not used for delicate tissue
HEMOSTATIC FORCEPS

 “Hemostats”
 Have a ratchet lock

 Used to clamp blood vessels (HEMO)

 Once clamped, vessel can be ligated (tied off)
RETRACTORS

 Hold tissues to expose surgical area so the

surgeon has a better view
 Self retaining or held by assistant
TOWEL FORCEPS/CLAMPS

 Surgical drapes cover animal during surgery

 Only area open is surgical site

 Clamps keep towel in place during surgery and

help prevent contamination
SPAY HOOK

 Used to bring uterus through tiny incinsion

SURGEON PREP

 Covered in bacteria naturally

 To prevent spread
 Gloves, mask, head cover, gown
 Wash hands (up to elbows) with
antiseptic soap and scrub brush
 Scrub should last 5 minutes to
properly clean
 Hold cleanest part highest (hands
in the air)
ANIMAL PREP

 Area cleared of general

debris
 Normally shaved or clipped
clean
 Loose hair is vacuumed off
 Scrubbed with antiseptic
soap , sometimes iodine
 Central region scrubbed first
then work outward in a
circular motion
TYPES OF SURGERY (GENERAL TERMS)

 “Clean”
 Healthyskin is entered, healthy tissue is removed
 Examples
 Spay/Neuter
OUTLINE A TYPICAL SURGERY
 Choose a typical surgery
 Spay

 Neuter

 Biopsy

 IntestinalObstruction
 Other (explain)

 Outline prep procedure, tools typical used and

procedure itself including suture
 Draw tools used
 JUST OUTLINE not complete sentences.
Laceration Healing

PRINCIPLES OF SURGERY
ESSENTIAL QUESTION

 How does a wound heal?

WOUND HEALING BASICS

 Understanding
healing is essential
to surgery and
trauma treatment
WOUND HEALING PROCESS

 Hemostasis Phase: Bleeding

 Begins directly after trauma or surgery breach
 Bleeding helps to flush the wound

 Instantly the vessels constrict, blood flow slows

 Blood starts to clot

 Protects from excessive blood loss
 Clot dries= scab
 Scab allows for protection and for healing underneth
WOUND HEALING PROCESS

 Inflammation Phase:
 Blood vessels dilate
 Bring more white blood cells to the area
 White blood cells help destroy damaged tissue and
bacteria
 Dilated vessels increase heat into the region and
produce red area
 Damaged tissue releases plasma and adds to the
swelling area
 Signs of inflammation phase
 Swelling, heat, redness, pain
WOUND HEALING PROCESS

 Repair/ Proliferation Phase

 Begins simultaneously with inflammation process
 Connective tissue enter the damaged area and
begin to form new fibrous connective tissue
 Proliferation of cells in the new connective fibers
and matrix
 Capillaries begin to grow within the area

 Produces a granular appearance on the skin

 Tissue at this stage is called granulated tissue
IMPORTANCE OF GRANULATED TISSUE

 This tissue fills the gap between the wound

edges and sets barrier from infection
 (Reminder)Rich supply of capillaries increases
amount of white blood cells
 As the G tissue forms E tissue form across the
edges
 Cells continue to layer and thicken
WOUND HEALING PROCESS

 Remodeling Phase
 Gap is closed (Second Intention Healing)
 Occurs within several weeks of wound, but can last
for years! (scar tissue)
 Connective tissue w/in the wound becomes more
organized and shrinks (scars shrink)
 Strength of wound increases over time
PROBLEMS IN WOUND HEALING

 Proud Flesh:
 Common in lower leg wounds in horses
 Over growth of granulated tissue prevents epithelial
tissue from covering the wound
ACTIVITY

 Illustrate the wound healing process

 Graphic organizer : Cause Effect Chain

Step Describe
Step Describe
Step Describe
one Two Three
MINIMIZING HEALING TIME

 Aseptic Techniques – decrease bacteria

 Gentle handling during surgery- decreases
inflammation response
 Appropriate incisions- less disruption of blood
supply = faster healing
BLEEDING IN WOUNDS AND DURING HEALING

 Dead space: important to consider

 Present because of tissue separation
 Tumor removal leaves a pocket

 Types of Accumulation
 Hematoma – accumulation of blood in the dead
open space
 Seroma- more puss like

 Abscess- contains bacteria, white blood cells, dead

tissues
 Fluid build up= increases tension @ wound site
REDUCING TENSION FROM FLUID

 Two main methods

 Decrease size of pocket during surgery
 Sew together tissues manually
 Latex tubing
 Penrose drain (passive)
 Active Drain
SUTURE ACTIVITY

 Outline the steps for suturing a wound.

 What are the TYPES of sutures
 What do they look like?

 How are they sewn? (only do a general outline for

sewing a wound closed)
 What are important items to consider when
suturing a trauma or surgical wound?
Surgical Considerations

PRINCIPLES OF SURGERY
BASIC CONCEPTS

 More than one method to a surgery

 Possible Differences
 Approach

 Orderof Steps
 Tech methods / Tools etc
TAKE A COMMON SURGERY : SPAY

 Aka Ovariohysterectomy
 Steps:
 Animal anesthetized and secured to table
 Scrubbed

 Start surgery
SPAY

 Most common
 Ventral Midline incision
 Middle of the stomach
 Why the midline?
 Abdominal muscles naturally have a gap (Linea Alba)
 Little bleeding , easy access to organs

 Locate Uterus (near the spine)

 Deep in cavity
 Use
spay hook to contact and begin uterine horn
removal
SPAY CONTINUED…

 Control blood flow

 Allarteries are ligated by the three-clamp method
 Vessels are sutured

 Clamps releases
 Check for leaking
 Ligaments cut
 Ligaments located
 Ligaments holding the uterus are ligated

 Uterus is free
SPAYING WRAP UP
 Organ removal
 Ovaries, uterine horns, uterine body all removed
 Cavity Check
 No bleeding in dead space
 Suture
 Sub Q tissue tightened to close dead space
 Absorbable using a tapered point needle
 Close Linea Alba
 Close epithelial label with NON absorbable suture
(stitches removed later)
EXPLORATORY : HORSE

 Same incision : Ventral Midline

 Possible findings?
 Looped intestine
 Blood supply cut off from segment
 Intestine become necrotic (dead)

 Reposition : If severe, section must be removed attaching

only healthy portions together ( intestinal anastomosis)
INTESTINAL/ GASTRIC TORSION IN DOGS
 AKA gastric dilation- volvulus syndrome (GDV)
 Occurs in deep chested breeds ( Boxer)
 Circulation to the stomach is disrupted
 Vomiting common symptom (food cannot move
forward, build up of gases)
 Diagnosis through radiographs / Xrays

 Treatment:
 IVfluids to reduce shock
 Tube down esophagus to relieve gas pressure
 If stomach is twisted surgery is needed
EXAMPLE 3: BLADDER STONES

 Ventral midline incision along linea alba

 Bladder brought the surface through incision

 Gauze surrounding surgical area to prevent

urine entering abdomen
 Incision of bladder

 Stones removed

 Continuous mattress suture

 Suture abdomen